血栓抽吸联合低剂量替罗非班对老年急性ST段抬高型心肌梗死患者心肌再灌注水平及安全性的影响

Effect of thrombus aspiration combined with low-dose tirofiban on myocardial reperfusion and safety in elderly patients with acute ST-segment elevation myocardial infarction

目的评价血栓抽吸联合冠状动脉内注射低剂量替罗非班对老年高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PCI)术后心肌再灌注水平及安全性的影响.方法选取2014年1月至2019年1月于马鞍山临床学院行PCI的老年STEMI高血栓负荷患者127例,随机分为观察组62例及对照组65例,观察组在常规PCI之前联合应用血栓抽吸和冠状动脉内注射低剂量替罗非班治疗,对照组采用常规PCI治疗.比较两组患者术后临床效果、出血事件及主要心血管不良事件(MACE)发生情况.结果术后观察组梗死相关动脉的TIMI血流3级、2 h心电图ST段回落>50%、LVEF均显著高于对照组[TIMI血流3级:57例(91.9%)比49例(75.4%),χ^2=2.295,P=0.040;心电图ST段回落>50%:50例(80.6%)比40例(61.5%),χ^2=5.611,P=0.018;LVEF值:(52.7±3.5)%比(50.9±5.0)%,t=2.229,P=0.028];观察组CK-MB峰值、碎裂QRS波、心包积液均低于对照组[CK-MB峰值:(274.4±173.1)U/L比(334.5±154.0)U/L,t=2.069,P=0.041;碎裂QRS波:24例(38.7%)比38例(55.5%),χ^2=4.955,P=0.026;心包积液:6例(9.5%)比15例(23.1%),χ^2=4.128,P=0.042];术后30天,观察组小/微出血事件多于对照组[小/微出血事件:7例(11.3%)比4例(6.2%),χ^2=4.019,P=0.043],大出血和卒中事件两组间比较差异无统计学意义(P>0.05);术后6个月,MACE事件两组间比较差异无统计学意义(P>0.05).结论血栓抽吸联合冠状动脉内注射低剂量替罗非班可改善老年高血栓负荷STEMI患者心肌再灌注水平,同时不增加严重出血风险,具有较高的临床应用价值.

Objective To evaluate the effect of thrombus aspiration combined with intracoronary injection of low-dose tirofiban on myocardial reperfusion and safety in elderly patients with acute ST-segment elevation myocardial infarction undergoing direct percutaneous coronary intervention.METHODS A total of 127 elderly patients with STEMI with high thrombus burden who underwent PCI at Maanshan Clinical College from January 2014 to January 2019.They were randomly divided into observation group(n=62)and control group(n=65).The observation group was treated with thrombus aspiration and intracoronary injection of low-dose tirofiban before routine PCI,and the control group was treated with conventional PCI.The postoperative clinical outcomes,bleeding events,and major cardiac adverse events(MACE)were compared between the two groups.RESULTS In the postoperative observation group,the TIMI blood flow of the infarct-related artery was grade 3,the ST segment of the electrocardiogram was decreased by 50%,and the LVEF was significantly higher than that of the control group[TIMI blood flow level 3:57 cases(91.9%)vs.49 cases(75.4%).,χ^2=2.295,P=0.040;ECG ST segment fall>50%:50 cases(80.6%)vs.40 cases(61.5%),χ^2=5.611,P=0.018;LVEF value:(52.7±3.5)%vs.50.95±5.0)%,t=2.229,P=0.028];CK-MB peak,fragmented QRS wave,and pericardial effusion were lower in the observation group than in the control group[CK-MB peak:(274.4±173.1)U/L vs.(334.5±154.0)U/L,t=2.069,P=0.041;QRS wave:24 cases(38.7%)vs.38 cases(55.5%),χ^2=4.955,P=0.026;pericardial effusion:6 cases(9.5%)vs.15 cases(23.1%),χ^2=4.128,P=0.042];30 days after operation,the observation group had fewer small/microbleed events than the control group[small/microbleeding events:7 cases(11.3%)vs.4 cases(6.2%),χ^2=4.019,P=0.043],there was no significant difference between the two groups in the major bleeding and stroke events(P>0.05);6 months after the operation,There was no significant difference between the two groups in the MACE event(P>0.05).Conclusions Thrombus aspiration combined with intracoronary injection of low-dose tirofiban can improve myocardial reperfusion in elderly patients with high thrombus burden STEMI,without increasing the risk of severe bleeding,and has a high clinical value.